Depression in Women

Learn about the issues surrounding women and depression ...

depression in women

For many women, living with the thoughts, emotions, and feelings inside their heads turns out to be a challenging, sometimes despondent and despairing, experience.

These particular women suffer with depression, and they suffer with this disorder more often than men. Of the roughly 19 million adult Americans with depression, approximately 12 million are women, according to Mental Health America (MHA).

Several research studies attempt to explain and understand this appreciable gap between genders. National data show that before age 10, there isn’t any discernible difference in the rate of depression among boys and girls. But from age 10 until about age 44, or midlife, differences in prevalence exist. After midlife, the differences in prevalence again disappear.

Researchers are trying to decipher the reasons that women suffer at higher rates than men. Most studies are still fairly inconclusive at identifying a direct cause and effect, but several risk factors have been identified. These factors include socioeconomic contributors, and biology.

Reproduction

The article “Depression in Women” published in Metabolism, Clinical and Experimental, examined the woman’s menstrual cycle, and its relationship to major depressive disorder (MDD). (For more information on diagnosing depression, see Types of Depression.)

Looking at cross-national data, author Dr. Rudolf E. Noble, noted a higher rate of MDD in women among all 10 countries examined (United States, Canada, Puerto Rico, France, West Germany, Italy, Lebanon, Taiwan, Korea, and New Zealand.) Regardless of ethnicity, women from these countries suffered with MDD at twice the rate of men.

Dr. Noble examined the data as it relates to all the major issues related to a woman’s reproductive biology, trying to show a correlation between the functioning of the endocrine system – the body’s hormone regulator – and a woman’s vulnerability to depression. He also explores reproductive mood disorders, depression during pregnancy, postpartum blues and depression, and menopause.

PMS and depression

For example, premenstrual syndrome (PMS), a reproductive mood disorder that begins five to 11 days before a woman’s menstrual cycle, and the more severe premenstrual dysphoric disorder (PMDD), both include symptoms of mood swings, irritability, and feelings of sadness and hopelessness.

The causes of PMS and PMDD have not been identified, but scientists theorize that hormonal fluctuations that take place during the menstrual cycle – namely in progesterone and estrogen - could be a major contributing factor. However, Noble states in the article, the severity of these symptoms aren’t likely tied to the amounts of these hormones, but how these hormones affect brain chemistry.

He specifically identifies the neurotransmitter serotonin, the brain’s chemical that controls appetite, sleep, muscle contraction, and mood – the neurotransmitter that scientists know to be intricately involved with depression. Either anatomical irregularities in the brain, or a chemical-producing mechanism cause levels of serotonin to deviate from normal, fully functioning levels, leading to depression.

Noble said that serotonin’s direct involvement with fluctuating hormones has yet to be empirically substantiated, yet indirect evidence from many studies strongly suggests a link. One example, he notes, is pharmaceutical validation. Most women with PMDD who take medications that regulate serotonin effectively relieve the severity of their symptoms.

Pregnancy

Approximately 25% to 35% of pregnant women suffer with depression, according to Noble. However, about 10% suffer with the more severe MDD. One of the major risk factors for MDD during pregnancy is a history of depression, or a past episode of major depression.

In fact, according to the Depression Clinic of Chicago Blog, with or without pregnancy, male or female, those who have had one episode of major depression have a 50% chance of a second episode. Individuals with two prior episodes have a 70% chance of a third.

So during a pregnancy, a woman’s history indicating a prior episode of depression, or chronic depression, is taken seriously.

Additionally, a number of socioeconomic and environmental conditions have also been shown to increase depression during pregnancy, including limited social support, living alone, a greater number of children, conflict in the marriage, illness or loss of a spouse, and other chronic physical or mental disorders.

Postpartum depression

After pregnancy it’s quite common for all women to experience a two to three week period of postpartum blues. However, of the 50% to 80% who suffer with postpartum blues, 25% will develop postpartum depression. And another smaller percentage of women will develop an extremely serious type of postpartum psychosis.

Researchers speculate that the rapid decline in reproductive hormone levels that take place after a pregnancy is responsible for postpartum depression. However, they also point to other socioeconomic risk factors, such as social isolation, educational attainment, unplanned pregnancy, and a long interval between marriage and childbirth.

Perimenopause and menopause

Noble theorizes that the same hormonal fluctuations that affect the serotonin neuronal systems in premenstrual syndromes and postpartum depression also relate to an increased tendency for women to become depressed during perimenopause and menopause.

Perimenopause occurs directly before menopause when the body is starting to transition into menopause. Menopause doesn’t actually begin until a woman has stopped menstruating for 12 consecutive months.

Large hormonal fluctuations take place during these time periods, causing a number of unpleasant symptoms, such as hot flashes, vaginal dryness, sleep disturbances, headaches, night sweats, fatigue, and irritability.

Socioeconomic contributors to depression during perimenopause and menopause include marital status, vulnerability to depression and a history of depression, educational background, poverty, substance abuse, and smoking.

Genetics

Scientists believe that hormonal fluctuations predispose some women to depression, especially those with serotonin-specific irregularities, but they also believe that other factors contribute to women’s depression.

Genetics is a key factor for many women with the disorder. In other words, a family history of depression highly correlates with a woman’s depression, whether experienced by a parent, grandparent, or other relative.

Women who suffer with either the major or MDD type of depression, or chronic depression, and have daughters need to be especially sensitive to genetic inheritance, educating their daughters about the signs and symptoms of this disorder.

In the American Journal of Psychiatry article “The Prediction of Major Depression in Women: Toward an Integrated Etiologic Model,” the authors summarized a study on 680 female twins. This study showed genetics directly affected a woman’s predisposition for the disorder.

However, the researchers also found that while genetics plays a major role, other factors also played a part in a woman’s depression – namely stressful life events.

Stressful life events

The study on twins credited stressful life events as having the greatest predictor of a woman’s depression – even before genetics.

These stressful life events included traumatic experiences from childhood, such as abuse or loss of a parent, to more recent stressful occurrences.

This finding also parallels the work of other researchers. Women typically experience more stress in today’s society, often juggling the major share of parenting, housework, and taking care of aging parents – all while maintaining full-time jobs.

Women are also more likely to live in poverty, and experience both physical and sexual abuse in their lifetimes – all risk factors for depression.

A multifactorial disease

Taken together, many scientists now understand that depression in women is a multifactorial disorder, meaning that the risks come from a number of factors that fall within the areas of both biology and environment.

In addition to traumas, other stressful factors to consider are the warmth and closeness of parents during early developmental stages, possibly impacting the ability of individuals to have successful social relationships later in life.

And societal pressures are intense, from school-related peer pressures (see Peer Pressure) and incidences of bullying (see Bullying), to media images of women that superficially emphasize attractiveness rather than intelligence or ability.

The combination of socioeconomic, cultural, hormonal, and genetic influences all play a part in the higher rates of depression in women, and an astute therapist or doctor must take into account all of these risk factors when diagnosing depression.

If you are interested in working as a mental health counselor with women and young girls struggling with depression, contact schools offering degrees in mental health counseling.

In most cases, at least a master’s degree is required, and most states also require licensing. Some positions also require a PhD in Psychology.

Sexualization of Girls and Depression

Advertisements of young girls in suggestive clothing, and in sexually suggestive positions are becoming more ubiquitous in this advertising-centered society, and few seem to be protesting too vehemently.

The American Psychological Association (APA), however, is raising awareness. It says that journalists, child advocacy organizations, parents, and psychologists have all voiced concern over the sexualization of girls, but their voices aren’t being heard. The APA is working to get the message to the public.

The organization has formed the APA Task Force on the Sexualization of Girls, and notes in an executive summary on its website that numerous research studies link sexualization with three of the most common mental health problems of girls and women: eating disorders, low self-esteem, and depression or depressed mood.

“In addition to mental health consequences of sexualization, research suggests that girls’ and women’s physical health may also be negatively affected, albeit indirectly,” an executive summary titled “Sexualization of Girls” states on the APA website.

Women, the summary states, are portrayed in a sexual manner more often than men in nearly every form of media.

Sexualization differs from healthy sexuality in that it refers to women dressed in revealing clothing, in bodily positions or with facial expressions that imply sexual readiness. This objectifies women, or makes sex and physical attractiveness more important than personality, or talents and intelligence. Women are viewed as decorative objects or as body parts rather than as multidimensional people.

And unrealistic standards of physical beauty, often emphasizing thinness, give young girls distorted ideas of the “ideal” body.

Examples are everywhere in today’s fashion and clothing industry.

Fashion designer Tom Ford took a guest editing position at French Vogue in 2010. He put a 15-year-old girl on one cover, eyes painted thickly, head tilted back, big red lips pursed in a pose that does not in anyway suggest she’s doing homework, playing the piano, or texting her BFF (Best Friend Forever). For most viewers, it’s a highly sexualized pose.

Inside the issue, he took it a step further. He did a complete spread of young – very young 6-year-old girls - pouting, wearing stilettos, laying on furs, and wearing makeup.

Ambercrombie & Fitch, known for its catalogues in the late 1990s showing teenage girls and boys together in their underwear, also gives many in the mental health field reason to worry.

In 2010, the retailer ran an online advertisement of a young teenager in a Gilly Hicks bra and panties placing her hands on the buttocks on two of five nude men. A&F followed that ad in 2011 with another online piece showing a young girl nude from the waist up, her arm across her breasts.

Research studies also point adversely to the future. Studies suggest that young women exposed to these ads now might be at a higher risk for depression in their later adult lives.